Changes in patient characteristics, glucose lowering treatment, glycemic control and complications in type 2 diabetes in general practices (Disease Analyzer, Germany: 2008-2016). Issue 2 (17th February 2018)

• Record Type: Journal Article
• Authors: Rathmann, Wolfgang; Scheerer, Markus; Rohwedder, Katja; Busch, Stefan; Kostev, Karel
• Is Part Of: Postgraduate medicine. Volume 130:Issue 2(2018)
• Page Start: 244
• Page End: 250
• Publication Date: 2018-02-17
• Subjects: Type 2 diabetes -- general practice -- glucose lowering drugs -- diabetes complications; Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610.5
• DOI: 10.1080/00325481.2018.1421842
• Languages: English
• ISSNs: 0032-5481

Abstract

ABSTRACT: Objectives : The objectives were to examine long-term changes in type 2 diabetes patient characteristics, diabetes treatment, control and complications in general practices. Methods : All type 2 diabetes patients were identified in a representative general practice database (Disease Analyser, Germany) in three periods (01/2008–12/2008: n = 90.866, 818 practices, mean age (SD): 67.6 (12.1) years, 51% males; 01/2012–12/2012: n = 179.923, 1.158 practices, 68.3 (12.6) years, 51% males; 10/2015–09/2016: n = 201.667, 1.184 practices, 68.2 (12.9) years, 52% males). Chi-square and Wilcoxon rank-sum tests were used for testing differences (2008 vs. 2015/16). Results : The mean number of type 2 patients per practice increased (2008: 111; 2015/16: 170). The proportion of retirees declined (74% vs. 61%) and patients in the working population increased (18% vs. 28%) (all p < 0.001). There were no relevant changes in mean HbA1c (7.1% vs. 7.2%), fasting blood glucose (141 mg/dl vs. 144 mg/dl) and BMI (31 kg/m 2 vs. 32 kg/m 2 ), whereas total cholesterol (204 mg/dl vs. 196 mg/dl) and triglycerides (159 mg/dl vs. 153 mg/dl) slightly declined (all p < 0.001). Prescription use of metformin, dipeptidyl peptidase-4 (DPP-4) and sodium dependent glucose transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists enlarged (dual or triple combinations) while sulfonylurea use decreased. Prevalence of polyneuropathy (6.2% vs. 8.6%), nephropathy (1.9% vs. 3.2%) and depression (7.6% vs. 10.0%) rised (all p < 0.001). Conclusions : General practitioners play a key role in diabetes care, increasingly treating type 2 diabetes patients in the working population. There was no change in glycemic control over the study period (2008–2016). The use of glucose-lowering drug combinations increased and microvascular complications were more often recorded.